MEDICARE: DR. KATIE RUBEDOR-GREEN PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	LP7267	MN

General Provider Information

NPI Number	:	1437049707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATIE RUBEDOR-GREEN PSYD

Provider Business Mailing Address
First Line	:	520 OSBORNE RD NE STE 210
Second Line	:
City	:	FRIDLEY
State	:	MN
Zip	:	55432-2718
Country	:	US
Telephone Number	:	763-236-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 OSBORNE RD NE STE 210
Second Line	:
City	:	FRIDLEY
State	:	MN
Zip	:	55432-2718
Country	:	US
Telephone Number	:	763-236-3800
Fax Number	:	763-236-3821

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2025
Last Update Date	:	01/05/2026

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